Huang Chen-Wei, Huang Mu-Shiang, Su Pei-Fang, Chao Ting-Hsing, Lee Cheng-Han, Liu Ping-Yen
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University.
Department of Statistics, College of Management.
Acta Cardiol Sin. 2023 Mar;39(2):277-286. doi: 10.6515/ACS.202303_39(2).20220821A.
The optimal alternative treatment strategy to coronary artery bypass graft surgery (CABG) for in-stent restenosis (ISR) in left main (LM) coronary artery disease remains uncertain.
We retrospectively screened all intervention reports from an intervention database and extracted those mentioning an LM stent. We then manually confirmed reports involving LM ISR and divided them into two groups, those in which the patient received a new drug-eluting stent (new-DES) strategy, and those in which the patient received a drug-coated balloon (DCB) only. A composite endpoint of major adverse cardiovascular events (MACEs) and each individual endpoint were compared. We also performed a brief analysis of similar designed studies.
Between the new-DES (n = 40) and DCB-only (n = 22) groups, during median respective follow-up times of 581.5 and 642.5 days, no significant statistical differences were detected in MACEs (50.0% vs. 50.0%, p = 0.974), cardiovascular death (27.5% vs. 13.6%, p = 0.214), nonfatal myocardial infarction (30.0% vs. 31.8%, p = 0.835), or target lesion revascularization (35.0% vs. 45.5%, p = 0.542). We analyzed four similar studies and found comparable MACE findings (odds ratio: 0.85, 95% CI: 0.44-1.67).
Our findings support both DCB angioplasty and repeat DES implantation for LMISR lesions in patients who were clinically judged to be unsuitable for CABG; the treatments achieved comparable clinical results in terms of MACEs in the medium term.
对于左主干（LM）冠状动脉疾病支架内再狭窄（ISR），冠状动脉旁路移植术（CABG）的最佳替代治疗策略仍不确定。
我们回顾性筛选了干预数据库中的所有干预报告，并提取了提及LM支架的报告。然后我们人工确认了涉及LM ISR的报告，并将其分为两组，一组患者接受了新型药物洗脱支架（new-DES）策略，另一组患者仅接受了药物涂层球囊（DCB）治疗。比较了主要不良心血管事件（MACE）的复合终点和每个单独终点。我们还对设计相似的研究进行了简要分析。
在new-DES组（n = 40）和仅DCB组（n = 22）之间，在各自的中位随访时间581.5天和642.5天期间，MACE（50.0%对50.0%，p = 0.974）、心血管死亡（27.5%对13.6%，p = 0.214）、非致命性心肌梗死（30.0%对31.8%，p = 0.835）或靶病变血运重建（35.0%对45.5%，p = 0.542）方面均未检测到显著统计学差异。我们分析了四项相似的研究，发现MACE结果具有可比性（优势比：0.85，95%可信区间：0.44-1.67）。
我们的研究结果支持对临床判断不适合CABG的患者，采用DCB血管成形术和重复DES植入治疗LMISR病变；就中期MACE而言，这两种治疗取得了相当的临床效果。
